Making ACA work, part 1

Eight years ago, the government opened enrollment in Medicare Part D, the prescription drug benefit. I remember talking to people involved in the rollout, and it sounded terribly confusing. I could easily imagine how confused elderly people might be by its competing plans. I remember no one had a clue how expensive it would be. The White House had prevented one pencil-pusher from testifying before Congress, as I recall, because his cost estimates were far higher than the administration’s talking points. It squeaked through Congress on a close vote, with Dick Armey twisting arms and stopping the House vote clock and Billy Tauzin earning his job with Big Pharma by handing out bribes on the House floor.

This is not promising, I remember thinking.

But people worked together to get the word out: doctors, Medicare and Social Security administrators, Councils on Aging, pharmacies, drug companies. They helped Medicare beneficiaries understand the options and figure out the best deal for them. It helped that even those who opposed the bill didn’t try to undermine it at every turn. No political group put commercials on TV telling seniors to boycott Medicare Part D. No governors refused to help. No state passed a law prohibiting its employees – or anyone else – from helping Medicare beneficiaries understand the program. No one characterized it as the mark of Satan or the cassus belli for a new American revolution.

Medicare Part D has proved to be popular. It’s not seen as a disaster, the ruination of the health care system or the economy. They made it work, which is one reason I take with a grain of salt all the hysteria about what a terrible, horrible disaster the Affordable Care Act is. People acting in good faith can make this law work. It can help millions of people who have serious health and health insurance problems.

My guess, though, is that the success of ACA implementation will vary from state to state. It will work a whole lot more smoothly in states with governors who want it to work.

It is the moral and legal duty of every American to sabotage and undermine obamacare to the greatest extent possible until the legislation that marks the lowest point in American history joins prohibition in the garbage bin of history. The battle is joined.

The point Rob willfully ignores and tries to shout down with hysterical and overwrought analogies is that there is “something to do” when you don’t like a law that’s on the books. There’s actually a number of things to do. Improve the law by amendment, repeal it altogether if you have the votes —appeal to the courts if you genuinely believe it’s somehow outside the bounds of the constitution. Failing that, with the very least measure of respect for your fellow citizens, you respectfully try to persuade until you have enough votes to try all of the above again.

There is a moral obligation to fight evil. The war has just begun. Every candidate for the next election cycles will be weighed on this scale. It will be brought down. In the meantime, the watchword is resistance.

Your candidates in the next election cycle will have to do a better job than you are doing in explaining WHY providing affordable health insurance to the uninsured is “evil.” Using wildly inappropriate comparisons of a safety net program to rape and slavery doesn’t strike me as a great messaging strategy. How stupid do you think voters are?

Rick makes a good point. Even those who saw the flaws in Medicare Part D at least saw it as a gesture towards the problems. Nevertheless a product of of our own making, a tool that could be turned to the basic task of helping people, that maybe could and should be reformed and improved one day if possible.

The commentary on Part D and attempt to make it analagous with the Patient Protection and Affordable Care Act misses a few key points:

1. The major argument in the House of Representatives over the new Part D and enhanced Part C in 2003 (the reason that they had to pull the plug on the clock, a time honored Democratic tradition) was exactly the same argument by the same people: the conservatives thought the new Part D and enhanced Part C would cost too much. The conservatives are being totally consistent today.

2. Meanwhile a side argument during the debate leading up to the vote but not really having anything to do with the clock or Big Pharma (can you document the bribery charge?) was the Democrats not wanting
— to give a large percentage of seniors a chance to get off Medicaid and VA and not wanting to let the market work its magic and lower drug costs and increase drug availability to seniors (before that, the government negotiated drug costs for a large percent of seniors, especially vets, and paid top dollar and could not often even get them the drugs they needed because they were not on the Medicaid/VA formulary– and still aren’t)
— not wanting to give an even larger percentage of seniors a choice of their healthcare insurance, a program better than Original Democratic Party Medicare

In other words, the vote you are recalling was not just about a drug program as you imply.

In the end, and admittedly it’s never pretty, most of the Republicans in the House voted for the most successful healthcare law in the last 45 years and the all but a few Democrats opposed it. To this day, the Democratic Party proposes repealing Parts C and D every year (sound familiar; given the Democrat’s ongoing desire to repeal Parts C and D of Medicare is there any doubt that if they were in the majority they wouldn’t try to defund them; in fact in PPACA they made Part D more expensive and “defunded” assistance to the poor on Part C)

As we reach the 10th anniversary of the Part C/D law, it’s turned out to work just like Bush predicted:
— The costs to the government of Part D are about half what was projected by Foster (the guy who couldn’t speak at the hearing you allude to; of course his predictions were fully released; it’s not like they didn’t release his data as you imply; and –again–this had nothing to do with stopping the clock and your alleged bribes)
— The costs to middle-income seniors for Part D are about half what was projected (I haven’t looked yet at the new 2014 prices announced last night so not sure if that’s still true)
— Vets and low-income seniors can get the drugs they need because they are on Medicare rather than Medicaid/VA; and they can get them at almost no cost, even in premiums
— It looks like (but it will take a generation of seniors taking their meds to be sure) the part D plan might pay for itself because people taking their drugs are making much fewer demands on the Parts A and B trust funds
— The percentage of seniors on public Part C Medicare Advantage health plans has increased from about 5% to almost 30%, and the percentage of seniors forced to buy expensive private Medigap insurance has decreased substantially
— Unfortunately the assistance to the rural and inner-city poor that was included in the Part C part of the 2003 law was removed (you might say “defunded”) by the Democrats through PPACA, forcing millions of poor people back on to Democratic Party Medicare (and Medicaid), which is the way the Democrats want to treat their constituents so the constituents will know who’s in charge.

Dennis, thanks for responding to the substance and refreshing my memory. I wouldn’t pretend the two programs are totally analogous. I just found some of the fretting about confusion in the implementation phase familiar. And I don’t recall those who opposed Medicare D making efforts to undermine its implementation like those opposing the ACA are making today.

As for the citations you requested: Billy Tauzin, who guided the legislation through the House, resigned within weeks to take a $2 million a year job with Big Pharma. To my lights, that makes it the biggest bag job in congressional history, but that’s an opinion, and there was no indictment:

I also recall an ethics investigation of campaign contributions from Big Tobacco being distributed on the House floor during the vote, but I can’t find a specific reference. I did find this AP story shining a light on the arm-twisting opponents were subject to, by Tom Delay and others:

When I wrote my column for the MWDN in 2003 about this issue Rick and I were on the same page supporting the Democrats’ pledge of permanent repeal efforts. This is yet another example of Rick’s fickle partisanship. He seems to like bad law when it comes from Democrats, but he is passionate about the crimes of bad law when it came from Bush.

I fully trust neither Rob’s memory nor my own. I can recall being critical of Tom DeLay’s tactics and Tauzin’s bag job, but I never opposed extending Medicare coverage to prescription drugs. I thought it was a necessary modernization of a law written back when drugs were less central to medical treatment. And I don’t recall advocating or even hearing about permanent repeal. I do recall objecting to the provision prohibiting Medicare from negotiating lower drug prices, and maybe I wanted that part repealed.

But don’t put me next to you in the “people who aren’t rich should get sick and die” faction.

The reason why maintain a clipping file is so that I don’t need to trust anyone’s subjective memory. Back in 2003, I was accusing of spewing hatred and partisanship for never supporting anything W did. I believe I was in the 7% who opposed the Iraq War, although today everyone claims to have been in the resistance. My position back then was that the Democrats should keep attempting to repeal this until it was dead. I also wrote on this blog that on the very first day of the Democrat Congress, Democrat Senate and Obama, the very first day, that piece of crap legislation should have been repealed, to a chorus of “hear, hear” from this very peanut gallery. I believe I had lumped into a proposal for an omnibus bill including repeal of DOMA, an immediate exit from Iraq and Afghanistan and a handful of other items from the liberal wish list dating back to the Reagan era. If you are keeping count, the Democrats, controlling both houses and the white house, did not move to do any of that good stuff. The Democrats simply morphed into the W third term. And, yes, Rick, you agreed back then that repeal would serve the Republicans right, reminding them that no one governed permanently.

Multi-decade consistency is clearly a higher priority to you than it is to me. I take some comfort in knowing my great thoughts today will be in the recycling bin next week.

I still don’t see why the prescription drug bill should be repealed today, or in Jan. 2007 (which was before this blog existed, I think). I seem to recall Democrats favoring the extension of Medicare to cover prescription drugs. Why not?

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